17574 - Laserfiche WebLink

Home Browse Search

F R,OFFICE USE: �V--- ---------- �� 377 71 ,7 ZI APPLICATION FOR SANITATION PERMIT Permit No. ... - ----------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is mde in compliance with County.Ordinance No. 549. JOB ADDRESS AN LOCATION:=_ _ _. "'�" � ---------------O------ .Owner s Name---- -- -- ---------•-- - ------------------ ---------- Phone --------------- x4 `�--g.6 3---------- .Owner's Address .� ----------------------------------------- ---- ------------------- Contractor's Name---------------------- ---------•---------------••--------------------------- ---------------------------- Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I-_ Number of bedrooms .a2.. Number of baths _aZ, Lot size __ -- ------- -------- Water Supply: Public system ❑ Community system ❑ Private jo, Depth to Water Table 9D ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------_------------) No ❑ New Construction: Ye X No ❑ FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��51.•� ti,y4,,. r — Septic Tank: Distance from nearest well__•______Distance from foundation__©____.----- _E..__._-_______________..------- aG _#,/ No. of compartments---I-----"r-.__------ _Size. +` _ Liquid dep�h_lv- Capacity__ ____--- * �- --- - --- �'' } Disposal Field: Distance from nearest weII..S�._- Distance from founclation___�_ _A--_-_-.Distance to nearest lot lire__ Number of lines____1 Length of each line _ - --------, - Width of trench---_,2_y.___ _._----t-._-- ----- - - ------ Type of filter Depth of filter material- 1 ---------_Total length----------------------------------------- Seepage ------_-Seepage Pit: Distance to nearest we11/0__4..........Distance from foundation-3.16_-._.___Distan to nearest lot line__,460-.- Number of pits.-..-----------.--Lining material_�D___ ----Size: Diameter---A3__43_-__.--_--Depth------R-.-%—--------------- fib Cesspool• Distance from nearest well-----------------Distance from foundation__.-------_-__.--_lining material-.._----.------.--_----_---_--------A r_1 Size: Diameter--------------------------------- Depth.-------------------------- Liquid-Capacity gals. Privy: Distance from nearest'well----------------------------------- -----------Distance from earest building------.----------------------:E-------._. ❑ Distance to nearest lot line.---- ----- -- -----------•-----;------- -------------T--- -- ---•-- Remodeling and/or repairing (describe):-- `= , - T - -----------•-----------------------------------•----------- ------- ------------------------------------------------ -------- ---------------------M----A----------------------- -------------M------A-------M-M---------r---------------------------M------ ----------------W-------------------- -----------------------------•---------------------------------------------------------------------------------------•---------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancesf to laws,sand rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor] (Signed)-- --------------- ---- -------------- ..... i -- ---------- ----- By:--------------------------------- -- --- - ---&-- ----------------------------(Title)-44t = �' - -- - -- --------- ------ - (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reve`rse side). i FOR DEPARTMENT USE ONLY ; t �, APPLICATIONACCEPTED -------------- =•;y=---------- -`----------- ------------------------------- DATE--_"1--� --------- ------ ---- --- = REVIEWEDBY-------------------------- -------- --------- --------------------------------------------- ------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------I { DATE Alterationsand/or recommendations:- -------- -------------------------------••-------------- ---------------•---------------••--•-----•------------------------------------------- _•-------_ --.--- ------------------•--------------- ---------------------•--_.---_--__._.--___•---.._------..._------------------------------- 1 a2.,� s� FINAL INSPECTION BY:--------_e_ ------- Date--. ------ ------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT S 124 Sycamore Street 205 West 9tt,Street i ]601 E.Na:altan Ava. 300 West Oak Street f li Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REViSEo 9.59 3M 3-'63 F.R[20.